Drug-eluting Stents in Acute Coronary Syndrome: Is There a Risk of Stent Thrombosis with Second-Generation Stents?

Abstract

The published version is also freely available and accessible from the publisher's webiste. The European Journal of Cardiovascular Medicine is an Open Access journal.\ud
This article is also freely available in PubMed.Over the past decade, the advent of drug-eluting stents (DES) has revolutionised the field of\ud
interventional cardiology by having a major impact on patient care through their efficacy in reducing\ud
the need for repeat revascularisation. A number of stents capable of delivering an anti-proliferative\ud
agent designed to prevent neointimal hyperplasia, the principal mechanism of restenosis after\ud
stenting, have been evaluated; four of these devices are currently approved by the U.S. Food and Drug Administration (FDA). Bare metal stent (BMS) and first-generation DES, such as sirolimus-\ud
eluting (SES-Cypher®) and paclitaxel-eluting stents (PES-Taxus®), have further improved results of percutaneous coronary intervention (PCI) by improving early results and reducing the risk of\ud
restenosis. However, there is currently debate on the safety of these first-generation DES, given the potential for late stent thrombosis (LST), especially after discontinuation of dual antiplatelet therapy.\ud
Second-generation DES, such as zotarolimus-eluting (ZES-Endeavor®) and everolimus-eluting stents (EES-Xience V®), are become available in the USA and/or Europe. Recently, long-term results\ud
comparing DES with BMS in patients with ST-segment-elevation MI (STEMI) have raised some\ud
questions about the long-term risks of the drug-eluting devices. It may be useful to pause, reflect for a moment, and consider some recent pertinent results regarding their wider use. This\ud
systematic review tries to provide a concise and critical appraisal of the data available to compare\ud
first and second generation stents especially to assess risk of stent thrombosis (ST) with second-\ud
generation DES.Peer-reviewedPublisher PD